This study examined the effects of the probiotic supplement Renadyl (Kibow) on 25 patients with chronic kidney disease (CKD) stages 3 and 4. 11 patients had diabetes and 14 did not. All patients received the probiotic or placebo for 3 months, then crossed over to the other. The probiotic significantly reduced blood urea levels in both groups. It only significantly reduced creatinine in non-diabetic patients. The study concluded the probiotic may benefit CKD patients, but larger and longer studies are needed, especially regarding antibiotic use and diabetes status.

1. THE BENEFICIAL EFFECT OF RENADYL (KIBOW)
PROBIOTICS ON PATIENTS WITH CHRONIC KIDNEY
DISEASES, WITH COMPARISON BETWEEN
DIABETIC AND NON DIABETIC PATIENTS
Dr. Alaa Hussain A. Awn
Consultant nephrologist
Sulaimani medical school

2. INTRODUCTION:
 Worldwide, the number of patients with Chronic
Kidney Disease (CKD) is rising and it is now being
recognized as a major public health concern that
is threatening to reach epidemic proportions in the
next decade.
 4.5% of the US adult population have Stage 3 and
stage 4 CKD.
 Reducing protein intake modifies the Creatinine
and lowers the blood urea in patients with CKD.

3.  Probiotic bacteria are commonly defined as live micro-
organisms, which, when administered in adequate amounts,
confer a health benefit to the host.
 Some of these bacteria were engineered to catabolize
unexcreted nitrogenous wastes within the intestine.(utilize as
nutrients ) ex:
 Urea
 Creatininte
 Methylamine
 nitrosamines
 Phenolic metabolic toxic compounds
 indole metabolic toxic compounds
 several other carcinogenic amines
 Previous studies suggest that the oral ingestion of a probiotic
bacterial regimen in patients with CKD was well tolerated, with a
decrease in blood urea nitrogen and uric acid, possibly
contributing to improve quality of life.

4.  Kibow biotic (K.B. = Renadyl Tm) is
formulated with food grade, gram positive
bacteria.
 Each enteric coated (for targeted ileo- cecal
delivery).
 The capsule contains a mixture of
Streptococcus thermophilus, Lactobacillus
acidophilus and Bifidobacterium longum,
for a total of 30 billion colony forming units
(CFU)

5. THE AIM OF THE STUDY
 1. To study the effect of K.B. in decreasing
the blood urea and serum creatinine in
patients with CKD stage 3 and 4.
 2. To study the effect of the K.B. by
comparison between diabetic and non
diabetic CKD patients.

6. METHOD:
 This was a prospective, randomized, double blind,
placebo controlled, crossover study of probiotic
bacteria dietary supplement (Kibow=KB=Renadyl)
 The study was conducted in Iraq,Kurdistan
regeon, Sulaimani city, at nephrology outpatient
clinic.
 25 outpatients with CKD stage 3 and 4, (11
patients were diabetic and 14 patients were non
diabetic).

7.  The study divided the patients into two
groups:
 Group A, 11 Diabetic patients, received the
probiotic supplement in the formulation
(KB), 3 capsules /day = 90 billion CFU.
 Group B, 14 non diabetic patients received
the placebo.,,, (Period 1, for 3 months).
 After 3 months, cross over was made.
Group A then received the placebo; Group B
then received the probiotic supplement.
,,(Period 2, for 3 months).

8.  The following assessments were conducted;
 medical history, documentation of disease and
physical examination.
 measurement of biochemical markers (Blood
urea, Serum creatinine (both measured in mg/dl),
Creatinine clearance, complete blood count, and
urinalysis. Ultrasonography of kidneys, ureters
and bladder.
 Dietary advice was given and the kibow product/
placebo were dispensed.

9.  Patients were periodically examined every month
for 3 month- periods for both groups. Physical
examination and complete laboratory testing were
performed at each visit.
 The results of renal function tests were taken at
the end of the second and the third month.
 The mean result was chosen as the effect of
formula on that group (placebo or kibow effect).
 The changes (the differences) in these parameters
were measured at the end of study (Placebo-

10.  Patients were treated and followed up
from April 2010 to June 2012.
 Outcomes were compared using
biochemical parameters; blood urea,
serum creatinine.

13. STATISTICAL METHODS
 The data were interpreted using SPSS (Statistical
Package for the Social Sciences-version).
 Descriptive statistics (numbers, percentages,
means, and standard deviation, minimum and
maximum) were calculated for all variables, and
analytical statistics were done to find the relations
between variables.
 Association between variables was detected by
using the appropriate statistical tests like t-test,
and analysis of variance (ANOVA). A p-value ≤

14. RESULTS:
 All the patients completed the study (at
least 6 months), whereby they received the
kibow probiotics dietary supplement at
least for 3 months.
 There was no statistical difference in these
parameters between both groups (the
diabetic and the non diabetic group).

16.  In comparison with the placebo period, renal
function tests (blood urea and serum creatinine)
were significantly decreased in all patients (As
one group study).
 Blood urea levels were significantly lower during
the KB treatment for both groups (diabetic and
non diabetic).
 However the serum creatinine changes were not
significant in diabetic group, but they were
significant in non-diabetic group.

20.  Regarding the effect degree of KB (placebo-
KB), which was represented by the mean
change (the decreasing value), on the blood
urea of all patients was 30.16 mg/dl.
 While the mean change (the decreasing
value) of serum creatinine of all patient was
0.71 mg/dl,

21.  There was a little effect of the KB on the
serum creatinine in 6 of the patients, who
needed antibiotic medications for long
period (for more than 2 week per month).

22. DISCUSSION

23.  The small sample size imposed the main limitation
in analysis of results in this pilot study as many
patients were not included in the study because
they didn’t finish the kibow course, because of
limitations in the availability of the product.
 Previous studies faced the same problem. A study
that was performed in Canada in 2008, where the
number of patients was 13.
 Other study was performed in USA, Canada,
Nigeria and Argentina (multicenter study) in 2009,
where the number of the patients was 46.

24.  The kibow probiotic dietary supplement is a
safe product to be used in patients with
CKD stage 3 and 4, with no significant side
effects.
 No adverse effects were observed in those
patients using the product for long period.

25.  The main outcome of this study was
significant decrease in blood urea in all the
patients (diabetic and non-diabetic).
 There was no significant change in serum
creatinine in diabetic patients.
 This is may be secondary to chronic
antibiotic use in those patients and because
of the presence of neurogenic bladder in
some of them ( confirmed by urodynamic
study latter on).

26.  This was different from other studies
(Ranganathan N et al, Friedman EA et al), where
there was significant decrease in the blood urea
nitrogen only.
 This may be because they included all the patients
in one group including the diabetic and non
diabetic and not mentioning anything about the
history of antibiotic intake during their study, as it
may affect the results.
 Other studies only included the patients with
serum creatinine of more than 2.5mg/dl, while this
study included the patients with serum creatinine
of more than 1.7 mg/dl (as they fit with definition

27. RECOMMENDATION

28.  Further studies are needed to confirm the
beneficial effect of the kibow product on larger
group of patients, for longer period, with different
doses of the product.
 Also to compare the effect of the product between
the controlled and non controlled blood sugar
diabetic patients.
 And to study the effect of the product on patients
with stage 5 CKD.
 Suspect to have less effects of the product in
patients using antibiotics for long time and in

30. THANK YOU